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HPV test emerging as an alternative to the Pap smear

For years, the Pap smear was the standard when it came to detecting cervical cancer. Now doctors are shifting to the HPV test, which is thought to be more accurate.

Researchers at Moffitt Cancer Center in Tampa have developed a new test that can help guide cervical cancer screenings for women who test positive for HPV.

At one time, cervical cancer was the leading cause of cancer death for women the United States.

And while that rate has fallen significantly over the last 40 years, detection methods have mostly stayed the same. Until now.

Gynecologists have been screening for cervical cancer for years through routine Pap smear exams by testing for potentially precancerous and cancerous cells in the cervix.

But clinicians are shifting to screening specifically for the human papillomavirus, or HPV, an infection that causes nearly all cervical cancers, to improve accuracy as they work to prevent the disease.

More than 79 million Americans are currently infected with a strain of HPV, according to the Cleveland Clinic. And roughly 14 million people are newly infected every year.

About 80 percent of sexually active people, both men and women, are infected with HPV at some point in their lives, but most rarely ever know it or are affected in any way. Still, there are 12 strains of HPV that are known to cause cervical cancer in women. The HPV vaccine aims to protect women and men from those strains.

Because of the dramatic rise of HPV, screenings for the infection are becoming more popular. That has prompted the birth control delivery company, Nurx, to launch an at-home HPV screening test this month. Women receive the test in the mail and can perform it at home. It requires a vaginal swab, and the collection is sent in the mail to be tested, said Jessica Horwitz, the company’s clinician director.

“If the results are positive, we recommend the patient follow up with a provider in person,” she said. “But the standard guidelines are if the test is negative, you don’t need to repeat the test for the next three to five years.”

Nurx is an app-based service where users can already sign up to have birth control or the HIV-prevention medication, PrEP, sent to them in the mail. The company charges a $15 shipping fee and bills insurers for pharmacy services, though patients can pay out of pocket.

Patients don’t necessarily need to have a doctor’s prescription to use the service. Horwitz said Nrux is a kind of “telemedicine” service that aims to provide greater access to care to people who may not be able to see a doctor.

Access has become a concern as numbers reveal that too many women have been slow to get screenings.

A study published this month in the Journal of Women’s Health shows a decline in screenings for women in the 21 to 29 age range for cervical cancer and HPV. Just over half of the women in that group were current on their screenings in 2016, a number the study’s author found “acceptably low.”

“The traditional medical system is slow to catch on,” said Horwitz, the Nurx executive. “It’s a bit polarizing. But the rate of women coming in for routine exams is lower and lower.”

In another recent twist, researchers at Moffitt Cancer Center in Tampa have developed a new test that can help guide cervical cancer screenings for women who test positive for HPV. According to a National Cancer Institute study, this new HPV test can more accurately predict whether an HPV-positive woman would develop cervical cancer within five years compared to a Pap test, where the results can vary.

The test uses a dual-stain method to measure the presence of two proteins that in combination have shown to be an accurate and dependable way to detect pre-cancerous cells. In the study, HPV-positive women who had a negative result on the dual-stain test had a low risk of developing cervical cancer over the next five years. Therefore, researchers concluded these women could wait three years before being screened again.

This screening method is still too new to be put into everyday practice among gynecologists, but it’s a step in the right direction to earlier detection and prevention, said Dr. Robert Wenham, the chair and director of research in the department of gynecologic oncology at the Moffitt.

“Testing methods have stayed stagnant for a very long time,” Wenham said. “A lot of times results from a Pap smear can come back a little funny, and we just don’t know how quickly pre-cancerous cells can change.”